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Murakami R, Kamikubo A, Morioka D, Kuroki H. Forensic analysis of suicide deaths: Comparing forensic information with public information and investigating factors contributing to psychiatric consultations. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e194. [PMID: 38868080 PMCID: PMC11114437 DOI: 10.1002/pcn5.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 06/14/2024]
Abstract
Aim This study aimed to examine the usefulness of forensic information on suicide deaths in Japan for epidemiological studies on suicide and determine the factors that lead people with suicidal ideation to seek psychiatric care prior to attempting suicide. Methods We focused on forensic information of 514 suicide deaths that occurred in Osaka City in 2019. First, to examine whether the data used in this study can be generalized to these cases, we compared the information on suicide deaths officially published by Osaka City with that used in this study, utilizing Pearson's χ 2 test. Next, the forensic data were analyzed using multivariate logistic regression analysis to confirm the relationship between demographic factors and the likelihood of having a history of psychiatric consultation before suicide. Results Both the official information and the data used in this study showed a higher number of males than females who died by suicide, with no significant differences in values between the data sets. Multivariate logistic regression analysis showed significant correlations. More females were associated with seeking a psychiatric consultation. However, those with regular jobs or students were more likely to avoid a psychiatric consultation. Conclusion The findings of this study provide insights into the phenomenon of suicide deaths by using a forensic perspective. The results of this study suggest that psychiatric consultation may be effective in reducing deaths by suicide. Forensic data should be incorporated into the formulation of suicide-prevention policies in Japan to conduct a more multifaceted analysis and improve suicide-prevention measures.
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Affiliation(s)
- Ryu Murakami
- Faculty of Emergency Medical ScienceMeiji University of Integrative MedicineNantanKyotoJapan
- Graduate School of Risk and Crisis ManagementChiba Institute of ScienceChibaJapan
| | - Atsushi Kamikubo
- Faculty of Emergency Medical ScienceMeiji University of Integrative MedicineNantanKyotoJapan
- Osaka Prefectural Medical Examiner's OfficeOsakaJapan
| | - Daigo Morioka
- Faculty of Emergency Medical ScienceMeiji University of Integrative MedicineNantanKyotoJapan
| | - Hisanaga Kuroki
- Graduate School of Risk and Crisis ManagementChiba Institute of ScienceChibaJapan
- Osaka Prefectural Medical Examiner's OfficeOsakaJapan
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Jobes DA, Mandel AA, Kleiman EM, Bryan CJ, Johnson SL, Joiner TE. Facets of Suicidal Ideation. Arch Suicide Res 2024:1-16. [PMID: 38174735 DOI: 10.1080/13811118.2023.2299259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
According to SAMHSA (2023), approximately 16,600,000 American adults and teens reported having serious thoughts of suicide in 2022. While suicide prevention has primarily focused on suicide deaths and attempts, we contend that suicidal ideation (SI) deserves more in-depth investigation and should be an essential intervention target on its own. In support of this point, we provide three examples of ways to improve specificity in understanding of SI through the study of controllability of SI, the language used to assess SI, and measuring SI in real time. We also consider qualitative work on the content of SI, its treatment, and definitional considerations. We thus call for an increased general focus on SI within research, clinical care, and policy.
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Bryan CJ, Allen MH, Bryan AO, Thomsen CJ, Baker JC, May AM. Does Suicide Risk Screening Improve the Identification of Primary Care Patients Who Will Attempt Suicide Versus Depression Screening Alone? Jt Comm J Qual Patient Saf 2023; 49:680-688. [PMID: 37739828 DOI: 10.1016/j.jcjq.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE The effectiveness of suicide risk screening relative to depression screening alone among primary care patients has not been tested rigorously. This study compared the performance of multiple depression screening methods (Patient Health Questionnaire [PHQ]-2, PHQ-8, and PHQ-9) and multiple suicide risk screening methods (PHQ-9 item 9 and suicide-focused screening of "thoughts of killing yourself" during the entire lifespan, within the past month, and within the past week) in a convenience sample of primary care patients. METHODS A total of 2,744 patients (military personnel, family members, and retirees) from six military primary care clinics completed the PHQ-9 and screening for suicidal ideation (SI) during routine clinic visits. Follow-up phone interviews were conducted for one year post-baseline to assess the incidence of suicide attempts, the study's primary outcome. Sensitivity, specificity, accuracy, and F1 statistics were calculated for each screening method for identifying patients who attempted suicide. RESULTS More than 65% of patients who screened positive for SI also screened positive for depression on the PHQ-9. Depression screening with the PHQ-9 correctly identified more patients who attempted suicide during follow-up than the PHQ-2, past week SI, and past month SI. The PHQ-9 correctly identified more patients who attempted suicide within 3 months than lifetime SI, but lifetime SI correctly identified more patients who attempted suicide within 6 and 12 months. CONCLUSION Depression screening with the PHQ-9 was the most effective strategy for identifying patients who attempted suicide in the near term. Universal suicide risk screening is unlikely to meaningfully improve identification of higher-risk patients beyond PHQ-9 depression screening.
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Fujieda M, Uchida K, Ikebe S, Kimura A, Kimura M, Watanabe T, Sakamoto H, Matsumoto T, Uchimura N. Fatigue on Waking, Insomnia, and Workplace Relationship Problems May Help to Detect Suicidal Ideation among New Middle-Aged Primary Care Patients: A 6-Month Prospective Study in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085547. [PMID: 37107831 PMCID: PMC10138726 DOI: 10.3390/ijerph20085547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023]
Abstract
Signs of suicidal depression often go undetected in primary care settings. This study explored predictive factors for depression with suicidal ideation (DSI) among middle-aged primary care patients at 6 months after an initial clinic visit. New patients aged 35-64 years were recruited from internal medicine clinics in Japan. Baseline characteristics were elicited using self-administered and physician questionnaires. DSI was evaluated using the Zung Self-Rating Depression Scale and the Profile of Mood States at enrollment and 6 months later. Multiple logistic regression analysis was conducted to calculate adjusted odds ratios for DSI. Sensitivity, specificity, and likelihood ratios for associated factors were calculated. Among 387 patients, 13 (3.4%) were assessed as having DSI at 6 months. Adjusted for sex, age, and related factors, significant odds ratios for DSI were observed for "fatigue on waking ≥1/month" (7.90, 95% confidence intervals: 1.06-58.7), "fatigue on waking ≥1/week" (6.79, 1.02-45.1), "poor sleep status" (8.19, 1.05-63.8), and "relationship problems in the workplace" (4.24, 1.00-17.9). Fatigue on waking, sleep status, and workplace relationship problems may help predict DSI in primary care. Because the sample size in this investigation was small, further studies with larger samples are needed to confirm our findings.
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Affiliation(s)
- Megumi Fujieda
- Department of Neuropsychiatry, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Fukuoka, Japan
- Department of Environmental Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Fukuoka, Japan
- Department of Healthcare Management, College of Healthcare Management, 960-4 Takayanagi, Setaka-machi, Miyama 835-0018, Fukuoka, Japan
- Correspondence: ; Tel.: +81-942-31-7564
| | - Katsuhisa Uchida
- Mental Health and Welfare Center of Shizuoka Prefectural Government, 2-20 Ariake-cho, Suruga-ku, Shizuoka-shi 422-8031, Shizuoka, Japan
| | - Shinichiro Ikebe
- Fuji Medical Association, 2850 Denbo, Fuji 417-0061, Shizuoka, Japan
| | - Akihiro Kimura
- Fuji Medical Association, 2850 Denbo, Fuji 417-0061, Shizuoka, Japan
| | - Masashi Kimura
- Fuji Medical Association, 2850 Denbo, Fuji 417-0061, Shizuoka, Japan
| | - Toshiaki Watanabe
- Fuji Medical Association, 2850 Denbo, Fuji 417-0061, Shizuoka, Japan
| | - Hisako Sakamoto
- Mental Health and Welfare Center of Shizuoka Prefectural Government, 2-20 Ariake-cho, Suruga-ku, Shizuoka-shi 422-8031, Shizuoka, Japan
| | - Teruaki Matsumoto
- Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka-shi 420-8527, Shizuoka, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Fukuoka, Japan
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Hallford D, Rusanov D, Winestone B, Kaplan R, Fuller-Tyszkiewicz M, Melvin G. Disclosure of suicidal ideation and behaviours: A systematic review and meta-analysis of prevalence. Clin Psychol Rev 2023; 101:102272. [PMID: 37001469 DOI: 10.1016/j.cpr.2023.102272] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/30/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023]
Abstract
Disclosure of suicidal ideation and behaviours, defined as thoughts, plans, or attempts, to other people provides opportunity for intervention and prevention. This study is the first to meta-analyze all available studies to estimate the prevalence of disclosure, to whom people disclose, and examine factors that influence disclosure. Databases were searched for studies reporting samples of people who had experienced suicidal ideation or behaviours (including those who had died by suicide) and whether they had disclosed this. Almost 100 studies (k = 94, N participants = 1,044,629) were included in the overall prevalance analysis. The results showed less than half of people disclosed suicidal ideation or behaviour: 45.9% (95%CI 41.9-49.9%, PI 12.3-81.8%; k = 94). High heterogeneity, common to prevalence studies, was found (Q[93] = 130,584, p < .001; I2 = 99.9%). No publication bias was detected. Removing outliers did not change the prevalence estimate, but provided tighter prediction intervals: 45.6% (95%CI 43.4-47.9%, PI 35.8-55.7%; k = 33). Disclosure was related to higher prevalence of psychiatric disorders, female gender, and a longer timeframe of suicidal ideation or behaviour. Prevalence of disclosure was lower among people who died by suicide, relative to community samples, and lower when reported verbally rather than written online. Disclosure, and proportions of disclosures, to family members, was numerically higher than to friends or professionals, but could not be directly compared. In conclusion, between 50 and 60% of people do not disclose their suicidal ideation and behaviours to other people, and therefore remain unidentified and potentially untreated.
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L’autopsie psychologique : un exercice scientifique ou un art divinatoire ? ANNALES MÉDICO-PSYCHOLOGIQUES, REVUE PSYCHIATRIQUE 2023. [DOI: 10.1016/j.amp.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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7
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Davico C, Rossi Ghiglione A, Lonardelli E, Di Franco F, Ricci F, Marcotulli D, Graziano F, Begotti T, Amianto F, Calandri E, Tirocchi S, Carlotti EG, Lenzi M, Vitiello B, Mazza M, Caroppo E. Performing Arts in Suicide Prevention Strategies: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14948. [PMID: 36429666 PMCID: PMC9690866 DOI: 10.3390/ijerph192214948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Suicide is a leading cause of death all over the world. Suicide prevention is possible and should be pursued through a variety of strategies. The importance of the arts for positive health outcomes has been increasingly evidenced. This scoping review aimed to identify the possible role of the performing arts-defined as a type of art performed through actions such as music, dance, or drama executed alive by an artist or other participant in the presence of an audience,-in suicide prevention programs. PubMed, Embase, PsycINFO, CINAHL, ProQuest Psychology Database, Scopus, and Web of Science were searched using terms in English for publications of original studies that included performing arts in suicide prevention programs. Thirty-five studies conducted between 1981 and 2021 were identified, of which only five were randomized clinical trials and four quasi-randomized studies. Interventions used different performing arts to improve awareness, self-efficacy, and soft skills relevant to suicide prevention. Studies were addressed mainly to gatekeepers but also directly to at-risk populations. While the study designs do not allow inferences to be drawn about the effectiveness of performing arts in preventing suicide, the review found that performing arts have been successfully implemented in suicide prevention programs. Research to evaluate the possible therapeutic benefit is warranted.
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Affiliation(s)
- Chiara Davico
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10100 Turin, Italy
| | | | - Elena Lonardelli
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10100 Turin, Italy
| | - Francesca Di Franco
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10100 Turin, Italy
| | - Federica Ricci
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10100 Turin, Italy
| | - Daniele Marcotulli
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10100 Turin, Italy
| | | | - Tatiana Begotti
- Department of Psychology, University of Turin, 10100 Turin, Italy
| | - Federico Amianto
- Department of Neuroscience, University of Turin, 10100 Turin, Italy
| | | | - Simona Tirocchi
- Department of Philosophy and Education Sciences, University of Turin, 10100 Turin, Italy
| | | | - Massimo Lenzi
- Department of Humanities, University of Turin, 10100 Turin, Italy
| | - Benedetto Vitiello
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10100 Turin, Italy
| | - Marianna Mazza
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Emanuele Caroppo
- Department of Mental Health, Local Health Authority Roma 2, 00159 Rome, Italy
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Hawton K, Lascelles K, Pitman A, Gilbert S, Silverman M. Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management. Lancet Psychiatry 2022; 9:922-928. [PMID: 35952701 DOI: 10.1016/s2215-0366(22)00232-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/20/2022]
Abstract
Suicide prevention in psychiatric practice has been dominated by efforts to predict risk of suicide in individual patients. However, traditional risk prediction measures have been shown repeatedly in studies from high income countries to be ineffective. Several factors might contribute to clinicians' preoccupation with risk prediction, which can have negative effects on patient care and also on clinicians where prediction is seen as failing. The model of therapeutic risk assessment, formulation, and management we outline in this article regards all patients with mental health problems as potentially at increased risk of suicide. It is aimed at reducing risk through use of a person-centred approach. We describe how a move towards therapeutic risk assessment, formulation, and risk management, including collaborative safety planning, could help clinicians develop a more tailored approach to managing risk for all patients, incorporating potentially therapeutic effects as well as helping to identify other risk reduction interventions. Such an approach could lead to enhanced patient safety and quality of care, which is more acceptable to patients.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | | | - Alexandra Pitman
- UCL Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | | | - Morton Silverman
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Chang TG, Hung CC, Huang PC, Hsu CY, Yen TT. Demoralization and Its Association with Quality of Life, Sleep Quality, Spiritual Interests, and Suicide Risk in Breast Cancer Inpatients: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912815. [PMID: 36232107 PMCID: PMC9566266 DOI: 10.3390/ijerph191912815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 05/16/2023]
Abstract
With decreasing mortality, the quality of life, spiritual needs, and mental health of breast cancer patients have become increasingly important. Demoralization is a poor prognostic factor for cancer patients. The extent of demoralization in breast cancer patients and its association with these factors remains unclear. This cross-sectional study was conducted at a Taiwanese medical center. We enrolled 121 participants (34 with high demoralization and 87 with low demoralization, as per the Mandarin Version of Demoralization Scale). High demoralization was associated with reduced quality of life, sleep quality, and spiritual interests. Multivariate analyses revealed that the scores of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire ≥ 62.5 (OR = 0.21, p = 0.002) and Spiritual Interests Related to Illness Tool Chinese Version ≥ 3.66 (OR = 0.11, p < 0.001) were associated with low demoralization. Demoralized patients with depression had a poorer quality of life and sleep quality. Although not statistically significant, depressed and demoralized participants were at a higher risk of suicide. Cancer patients with both depression and demoralization had the worst prognosis. Breast cancer patients exhibited demoralization when they had unmet bio-psycho-social-spiritual needs. An early assessment of demoralization may improve holistic healthcare for breast cancer patients.
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Affiliation(s)
- Ting-Gang Chang
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung 407612, Taiwan
- School of Psychology, Chung Shan Medical University, Taichung 40201, Taiwan
- School of Medicine, College of Medicine, National Yung Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Chih-Chiang Hung
- Division of Breast Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung 407612, Taiwan
- Department of Applied Cosmetology, College of Human Science and Social Innovation, Hungkuang University, Taichung 433304, Taiwan
| | - Pei-Ching Huang
- Cancer Prevention and Control Center, Taichung Veterans General Hospital, Taichung 407612, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force, Taichung Veterans General Hospital, Taichung 407612, Taiwan
| | - Ting-Ting Yen
- School of Medicine, College of Medicine, National Yung Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung 407612, Taiwan
- Correspondence: ; Tel.: +886-23592525
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Karabatsiakis A, de Punder K, Salinas-Manrique J, Todt M, Dietrich DE. Hair cortisol level might be indicative for a 3PM approach towards suicide risk assessment in depression: comparative analysis of mentally stable and depressed individuals versus individuals after completing suicide. EPMA J 2022; 13:383-395. [PMID: 36061827 PMCID: PMC9425778 DOI: 10.1007/s13167-022-00296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022]
Abstract
Depression and suicidal behavior are interrelated, stress-associated mental health conditions, each lacking biological verifiability. Concepts of predictive, preventive, and personalized medicine (3PM) are almost completely missing for both conditions but are of utmost importance. Prior research reported altered levels of the stress hormone cortisol in the scalp hair of depressed individuals, however, data on hair cortisol levels (HCL) for suicide completers (SC) are missing. Here, we aimed to identify differences in HCL between subject with depression (n = 20), SC (n = 45) and mentally stable control subjects (n = 12) to establish the usage of HCL as a new target for 3PM. HCL was measured in extracts of pulverized hair (1-cm and 3-cm hair segments) using ELISA. In 3-cm hair segments, an average increase in HCL for depressed patients (1.66 times higher; p = .011) and SC (5.46 times higher; p = 1.65 × 10−5) compared to that for controls was observed. Furthermore, the average HCL in SC was significantly increased compared to that in the depressed group (3.28 times higher; p = 1.4 × 10−5). A significant correlation between HCL in the 1-cm and the 3-cm hair segments, as well as a significant association between the severity of depressive symptoms and HCL (3-cm segment) was found. To conclude, findings of increased HCL in subjects with depression compared to that in controls were replicated and an additional increase in HCL was seen in SC in comparison to patients with depression. The usage of HCL for creating effective patient stratification and predictive approach followed by the targeted prevention and personalization of medical services needs to be validated in follow-up studies.
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Affiliation(s)
- Alexander Karabatsiakis
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Karin de Punder
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | | | - Melanie Todt
- Institutes for Forensic Medicine, Hannover Medical School, Hannover, Germany
| | - Detlef E. Dietrich
- AMEOS Clinic for Psychiatry and Psychotherapy, Hildesheim, Germany
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
- Center for Systems Neuroscience Hannover, Hannover Medical School, Hannover, Germany
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Weissman J. Reasoning about Death in Biomedical Decision-Making. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2022; 47:331-344. [PMID: 35926174 DOI: 10.1093/jmp/jhac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Depending on our mode of reasoning-moral, prudential, instrumental, empirical, dialectical, and so on-we may come to vastly different conclusions on the nature of death and the appropriate orientation toward matters such as euthanasia or procuring organs from brain-dead patients. These differing orientations have resulted in some of the most enduring conflicts in biomedical decision-making with roots in the earliest strands of philosophical discourse. Through continually grappling with questions over matters of death, we continually step closer to clarity, even if certainty on these matters remains necessarily as elusive as death itself.
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Fernando DT, Clapperton A, Berecki-Gisolf J. Suicide following hospital admission for mental health conditions, physical illness, injury and intentional self-harm in Victoria, Australia. PLoS One 2022; 17:e0271341. [PMID: 35816509 PMCID: PMC9273064 DOI: 10.1371/journal.pone.0271341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The majority of suicide decedents have had contact with health services close to their death. Some of these contacts include admissions to hospitals for physical and mental health conditions, injury and intentional self-harm. This study aims to establish and quantify the risks of suicide following hospital admission for a range of mental and physical illnesses. Methods A retrospective analysis was carried out on existing morbidity and mortality data in Victoria. Data was extracted from the Victorian Admitted Episodes Dataset and the Victorian Suicide Register. Unplanned hospital admissions among adult patients (> = 15 years of age), discharged between 01 January 2011 and 31 December 2016 (2,430,154 admissions), were selected. Standardised Mortality Ratios were calculated for conditions with at least five linked suicides within one year of discharge from hospital. Results Forty-three conditions defined at the three-digit level of the International Statistical Classification of Diseases and Related Health Problems 10th Revision, were associated with at least five subsequent suicides (within one year of hospital discharge); 14 physical illnesses, 5 symptoms, signs and abnormal clinical and laboratory findings, 12 mental health conditions, and 12 types of injury and poisonings. The highest Standardised Mortality Ratios were for poisonings (range; 27.8 to 140.0) and intentional self-harm (78.8), followed by mental health conditions (range; 15.5 to 72.9), symptoms, signs and abnormal clinical and laboratory findings (range; 1.4 to 43.2) and physical illnesses (range; 0.7 to 4.9). Conclusions Hospital admissions related to mental health conditions and injury and poisonings including self-harm were associated with a greater risk of suicide than physical conditions. Mental health conditions such as depressive episodes, personality disorders and psychotic episodes, injuries caused by intentional-self-harm and poisonings by certain types of drugs, carbon monoxide and hormones such as insulin can be prioritised for targeting suicide prevention initiatives for persons discharged from hospitals.
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Affiliation(s)
- Dasamal Tharanga Fernando
- Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
- * E-mail:
| | - Angela Clapperton
- Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
| | - Janneke Berecki-Gisolf
- Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
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Suicidal behaviour: What's the brain up to? J Psychiatr Res 2022; 146:210-218. [PMID: 35026694 DOI: 10.1016/j.jpsychires.2021.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Individuals with suicidal behaviours are increasingly recognized as having impairments in brain metabolism. However, these are not well delineated. AIM To evaluate regional cerebral glucose metabolism (rCMglu) in subjects with suicidal behaviours and assess differences in rCMglu between depressed and non-depressed suicidal subjects. METHODS Thirty-three subjects with suicidal behaviours were assessed using Columbia Suicide Severity Rating scale (CSSRS) and Beck's Depression Inventory (BDI). Brain metabolism was assessed using [18F]Fluoro,Deoxy-Glucose Positron Emission Tomography (FDG-PET). RESULTS Of 33 subjects, eighteen had depression. FDG-PET findings revealed that in comparison to mean asymptomatic controls, subjects had decreased rCMglu in right inferior frontal, left Broca's, left inferiolateral andsuperiolateral temporal, right inferior parietal and left posterior cingulate cortex. Increased rCMglu was seen in bilateral superior and medial frontal, right inferiolateral and posteriomedial temporal cortex, and midbrain. CSSRS total intensity inversely correlated with rCMglu in medial frontal cortex, left Broca's and superiolateral temporal cortex and directly correlated with rCMglu in right cerebellum. There was no significant difference in rCMglu between depressed and non depressed group. CONCLUSIONS Significant differences exist in rCMglu of suicidal individuals, chiefly in frontal and temporal regions. Understanding these would help us identify individuals more at risk for suicidal behaviours.
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Fernando T, Clapperton A, Spittal M, Berecki-Gisolf J. Suicide among those who use mental health services: Suicide risk factors as evidenced from contact-based characteristics in Victoria. Front Psychiatry 2022; 13:1047894. [PMID: 36569615 PMCID: PMC9772269 DOI: 10.3389/fpsyt.2022.1047894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The majority of suicide decedents have had contact with health services in the months before their death. Contacts for mental health services present potential suicide prevention opportunities. This study aims to compare contact-based characteristics among suicide decedents and living controls in the year subsequent to clinical mental health contact with the public health system in Victoria, Australia. METHODS A population-based nested case-control study of those who had mental health-related hospital and community contacts with the public health system was conducted. Cases (suicide decedents) were age and gender-matched to living controls (suicide non-decedents). These records were linked to records of suicides that occurred in the 12 months following the health service contact, between January 1, 2011, and December 31, 2016. Victorian residents aged 10 years and above were selected at the time of contact (483,933 clients). In the study population, conditional logistic regression models were used to assess the relationship between contact-based characteristics and suicide. Socio-demographics and mental health-related hospital and community contact data was retrieved from the Victorian Admitted Episodes Dataset, the Victorian Emergency Minimum Dataset and the Public Clinical Mental Health database and suicide data from the Victorian Suicide Register. RESULTS During a six-year period, 1,091 suicide decedents had at least one mental health contact with the public health system in the 12 months preceding the suicide. Overall, controls used more mental health services than cases; however, cases used more mental health services near the event. The relationship between the type of service and suicide differed by service type: hospital admissions and emergency department presentations had a significant positive association with suicide with an OR of 2.09 (95% CI 1.82-2.40) and OR of 1.13 (95% CI 1.05-1.22), and the effect size increased as the event approached, whereas community contacts had a significant negative association with an OR of 0.93 (95% CI 0.92-0.94), this negative association diminished in magnitude as the event approached (OR∼1). CONCLUSION Suicide decedents had less contact with mental health services than non-decedents; however, evidence suggests suicide decedents reach out to mental health services proximal to suicide. An increase in mental health service contact by an individual could be an indication of suicide risk and therefore an opportunity for intervention. Further, community level contact should be further explored as a possible prevention mechanism considering the majority of suicide decedents do not access the public clinical mental health services.
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Affiliation(s)
- Tharanga Fernando
- Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, Clayton, VIC, Australia
| | - Angela Clapperton
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | - Matthew Spittal
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | - Janneke Berecki-Gisolf
- Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, Clayton, VIC, Australia
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15
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The psychological autopsy. Four hypostases referring to a suicidal Dada artist. PSIHIATRU.RO 2022. [DOI: 10.26416/psih.71.4.2022.7325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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16
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Bijjal S, Ganiger F, Safeekh AT, Sharma M. A cross-sectional study of frequency, type, and lethality of deliberate self-harm in bipolar affective disorder patients presenting to tertiary care center. ARCHIVES OF MENTAL HEALTH 2022. [DOI: 10.4103/amh.amh_135_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Affleck W, Chawky N, Beauchamp G, Inukpuk MM, Annanack E, Paradis V, Séguin M. Suicides in Nunavik: a life course study. Int J Circumpolar Health 2021; 80:1880143. [PMID: 33691591 PMCID: PMC7954501 DOI: 10.1080/22423982.2021.1880143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/03/2022] Open
Abstract
This study reports results of a life course study conducted with Inuit in Nunavik to obtain information on the life adversities and cumulative burden of adversity for three groups: those who died by suicide, those who attempted suicide, and those who experienced suicidal ideation but never attempted. The study involved different levels of collaboration between health authorities, front-line health workers and the research team. Results indicate that substance misuse and relational difficulties are most associated with the burden of adversity for those people who died by suicide, while bullying is most associated with the burden of adversity for those people who have made suicide attempts and those who have never made a suicide attempt. Specifically targeting parent-child relations, substance misuse, and bullying may be an important upstream strategy for reducing future suicidality in Nunavik.
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Affiliation(s)
- William Affleck
- Department of Psychology and Psycho-education, Institut Universitaire En Santé Mentale Douglas, Montreal, Canada
- Université Du Québec En Outaouais (UQO), Gatineau, Canada
| | - Nadia Chawky
- Department of Psychology and Psycho-education, Institut Universitaire En Santé Mentale Douglas, Montreal, Canada
| | - Guy Beauchamp
- Université Du Québec En Outaouais (UQO), Gatineau, Canada
| | - Martha Malaya Inukpuk
- Sungirtuivik Family House, Inukjuaq, Canada
- Nunavik Regional Board of Health and Social Services, Kuujuaq, Canada
| | | | - Véronique Paradis
- Nunavik Regional Board of Health and Social Services, Kuujuaq, Canada
| | - Monique Séguin
- Department of Psychology and Psycho-education, Institut Universitaire En Santé Mentale Douglas, Montreal, Canada
- Université Du Québec En Outaouais (UQO), Gatineau, Canada
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18
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Hawkins EM, Coryell W, Leung S, Parikh SV, Weston C, Nestadt P, Nurnberger JI, Kaplin A, Kumar A, Farooqui AA, El-Mallakh RS. Effects of somatic treatments on suicidal ideation and completed suicides. Brain Behav 2021; 11:e2381. [PMID: 34661999 PMCID: PMC8613439 DOI: 10.1002/brb3.2381] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/14/2021] [Accepted: 09/14/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This work was undertaken to define and characterize the role of currently available somatic treatments in psychiatry in either increasing or reducing the risk for suicide. METHODS Members of the Suicide Prevention Task Group of the National Network of Depression Centers performed a literature review of somatic treatments known to increase or reduce the risk for suicide. The reviews ventured to include all relevant information about the risk for both suicide ideation and completed suicides. RESULTS Lithium and clozapine are the only two somatic treatments that have high-quality data documenting their antisuicide effects in mood disorders and schizophrenia, respectively. Lithium discontinuation is also associated with increased suicide risk. Ketamine and esketamine may have a small, but immediate, antisuicide effect. Despite the recent Food and Drug Administration approval of esketamine use in depressed suicidal patients, the small disproportional overrepresentation of suicide in subjects who had received esketamine versus placebo (3 vs. 0 among > 3500 subjects) requires ongoing evaluation. The purported antisuicide effect of electroconvulsive therapy is based on low-quality data. The effect of antidepressants is not at all clear. There appears to be direct evidence for antidepressants increasing suicidal ideation and the risk for suicide over the short-term in young people, but indirect (low quality) evidence that antidepressants reduce suicide risk over the long term. CONCLUSIONS Clinicians have an expanding pharmacopeia to address suicide potential in their patients. Some of the agents with documented antisuicide effects may also increase suicidality under specific circumstances.
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Affiliation(s)
- Elise M Hawkins
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
| | - William Coryell
- Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Stephen Leung
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Cody Weston
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John I Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Adam Kaplin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anupama Kumar
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali A Farooqui
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
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- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
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Al-Humadi S, Bronson B, Muhlrad S, Paulus M, Hong H, Cáceda R. Depression, Suicidal Thoughts, and Burnout Among Physicians During the COVID-19 Pandemic: a Survey-Based Cross-Sectional Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:557-565. [PMID: 34128193 PMCID: PMC8202962 DOI: 10.1007/s40596-021-01490-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/13/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Frontline workers have been a bulwark in the fight against COVID-19, while being subject to major unexpected stressors. These include conflicting news, evolving guidelines, perceived inadequate personal protective equipment, overflow of patients with rising death counts, absence of disaster training, and limitations in the implementation of social distancing. This study investigates the incidence and associated factors of depression, suicidal thoughts, and burnout among physicians during the COVID-19 pandemic. METHODS In a cross-sectional survey-based study of resident, fellow, and attending physicians from a tertiary university hospital during the height of the COVID-19 pandemic in New York from April 24 to May 15, 2020, demographics and practice specialty, attending vs. resident/fellow status, call frequency, emotional exhaustion, depersonalization, and depression severity were examined. RESULTS Two hundred twenty-five subjects completed the survey (response rate of 16.3%), with rates of 6.2% depression, 6.6% suicidal ideation, and 19.6% burnout. Depression, suicidal ideation, and burnout were all associated with history of prior depression/anxiety and frequency of on call. Suicidal ideation and burnout were also associated with younger age. There was no difference in rates of depression, suicidal ideation, or burnout between attending and resident physicians. Female physicians reported less work-life balance and more burnout. CONCLUSIONS These findings highlight the importance of considering physician mental health during times of peak stress, such as natural or man-made disasters. The prominence of premorbid depression/anxiety as a relevant factor underscores the need to further understand physician mental health and provide early screening and treatment.
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Affiliation(s)
| | | | | | | | - Houlin Hong
- Stony Brook University, Stony Brook, NY, USA
| | - Ricardo Cáceda
- Stony Brook University, Stony Brook, NY, USA.
- Northport Veteran Administration Medical Center, Northport, NY, USA.
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20
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Abstract
This paper offers a philosophical analysis of the connection between mental disorder and suicide risk. In contemporary psychiatry, it is commonly suggested that this connection is a causal connection that has been established through empirical discovery. Herein, I examine the extent to which this claim can be sustained. I argue that the connection between mental disorder and increased suicide risk is not wholly causal but is partly conceptual. This in part relates to the way suicidality is built into the definitions of some psychiatric diagnoses. It also relates to the broader normative assumption that suicidal behavior is by definition mentally disordered behavior. The above has significant epistemological implications, which I explore. I propose that the claim that suicide is connected with mental disorder cannot be justified solely by appealing to empirical evidence but also warrants a justification on conceptual and normative grounds.
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21
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Tae H, Chae JH. Factors Related to Suicide Attempts: The Roles of Childhood Abuse and Spirituality. Front Psychiatry 2021; 12:565358. [PMID: 33868033 PMCID: PMC8044867 DOI: 10.3389/fpsyt.2021.565358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 02/25/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: The purpose of this article was to identify independent factors associated with suicide attempts in patients with depression and/or anxiety. Background and Aims: This study was conducted in order to examine whether risk and protective psychological factors influence the risk of suicide attempts among outpatients with anxiety and/or depressive disorders. In this regard, explanatory models have been reported to detect high-risk groups for suicide attempt. We also examined whether identified factors serve as mediators on suicide attempts. Materials and Methods: Patients from 18 to 65 years old from an outpatient clinic at Seoul St. Mary's Hospital were invited to join clinical studies. From September 2010 to November 2017, a total of 737 participants were included in the final sample. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Childhood Trauma Questionnaire (CTQ), Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp-12), and Functional Social Support Questionnaire (FSSQ) were used to assess psychiatric symptoms. An independent samples t-test, a chi-square test, hierarchical multiple regression analyses, and the Baron and Kenny's procedures were performed in order to analyze data. Results: Young age, childhood history of emotional and sexual abuse, depression, and a low level of spirituality were significant independent factors for increased suicide attempts. Depression was reported to mediate the relationship between childhood emotional and sexual abuse, spirituality, and suicide attempts. Conclusions: Identifying the factors that significantly affect suicidality may be important for establishing effective plans of suicide prevention. Strategic assessments and interventions aimed at decreasing depression and supporting spirituality may be valuable for suicide prevention.
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Affiliation(s)
- Hyejin Tae
- Stress Clinic, Health Promotion Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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22
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An MMPI-2 hopelessness scale: Construction, initial validation and implication for suicide risk. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2020.100057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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23
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Yoon S, Park K, Choi KH. The ultra brief checklist for suicidality. J Affect Disord 2020; 276:279-286. [PMID: 32697710 DOI: 10.1016/j.jad.2020.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/31/2020] [Accepted: 07/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accurately identifying patients at an elevated risk of suicide in minimal time is an important mental health issue. Therefore, we developed the Ultra Brief Checklist for Suicidality (UBCS) and reported its psychometric properties. METHODS We studied 544 participants who had completed the UBCS, other self-report measures, and structured clinical interviews by trained interviewers. We explored the psychometric properties of the UBCS's paper-based and online versions by identifying optimal cutoff points, sensitivity, specificity, etc. of all participants. RESULTS The mean score of the UBCS (paper-pencil version) in the no-suicide-risk group was 0.23 (SD = 0.73), while in the Risk-Positive (RP) and the High-Risk (HR) groups it was 3.54 (SD = 3.22) and 6.31 (SD = 3.97), respectively. Optimal cutoff points for the RP and HR groups were 1 (AUC = 0.914) and 3 (AUC = 0.928), respectively. LIMITATIONS The current findings apply only to adults, not to children or adolescents. The original MINI was used as the assessment instrument's reference standard rather than MINI 7.0.2 of DSM-5. Predictive validity was not addressed as this was not a longitudinal cohort study. CONCLUSIONS The UBCS was rigorously tested and validated. More than half the participants completed the UBCS within a minute. It possesses adequate psychometric properties and can be easily administered with minimal clinician time and effort, via paper or Internet. We believe it can contribute to suicide risk identification and timely interventions.
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Affiliation(s)
- Seowon Yoon
- Department of Psychology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Korea
| | - Kiho Park
- Department of Psychology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Korea; KU Mind Health Institute, Korea University, Seoul, Korea
| | - Kee-Hong Choi
- Department of Psychology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Korea; KU Mind Health Institute, Korea University, Seoul, Korea.
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Menon V, Varadharajan N, Bascarane S, Subramanian K, Mukherjee MP, Kattimani S. Psychological autopsy: Overview of Indian evidence, best practice elements, and a semi-structured interview guide. Indian J Psychiatry 2020; 62:631-643. [PMID: 33896967 PMCID: PMC8052872 DOI: 10.4103/psychiatry.indianjpsychiatry_331_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/19/2020] [Accepted: 08/29/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND No review has been attempted, so far, on Indian psychological autopsy (PA) literature. There is also a dearth of interview guides which is at the heart of a PA procedure. MATERIALS AND METHODS Electronic searches of MEDLINE through PubMed, PsycINFO, and Google scholar databases were carried out from inception till February 2020 to identify relevant English language peer-reviewed articles from India, as well as global literature that provided information on best practice elements in PA. Abstracts generated were systematically screened for eligibility. Relevant data were extracted using a predesigned structured proforma, and a semi-structured interview guide was developed. RESULTS A total of 18 original articles, one case report, and three reviews/expert opinion articles which tried to give a description of PA procedure were found from India. Most Indian studies are of suicide PA (SPA), done to assess risk factors associated with suicide. There was a wide variation in reported rates of psychiatric morbidity among suicide decedents, while the other major risk factor for suicide in the Indian setting was stressful life events. An optimal approach to PA involves systematically collecting information from key informants and other sources using a narrative interviewing method, supplemented with psychological measures, and is probably best carried out within 1-6 months after the death. CONCLUSION There have been limited attempts to standardize PA. Most Indian studies use SPA. We propose a semi-structured PA interview guide, suitable for both research and investigational purposes.
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Affiliation(s)
- Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Natarajan Varadharajan
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Sharmi Bascarane
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Karthick Subramanian
- Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | | | - Shivanand Kattimani
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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25
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Steinberg LJ, Mann JJ. Abnormal stress responsiveness and suicidal behavior: A risk phenotype. Biomark Neuropsychiatry 2020. [DOI: 10.1016/j.bionps.2020.100011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Zacharakis CA, Hadjivassilis V, Madianos MG, Papadimitriou GN, Stefanis CN. Suicide in Cyprus 1988–1999. Eur Psychiatry 2020; 20:110-4. [PMID: 15797694 DOI: 10.1016/j.eurpsy.2004.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2003] [Revised: 08/16/2004] [Accepted: 11/04/2004] [Indexed: 11/28/2022] Open
Abstract
AbstractSuicide is a universally observed human behavior related to bio-psychological, social and cultural factors. The aim of the present study was to examine suicide in Cyprus, an island that has known many civilizations and cultures. All completed suicide cases in the Christian population of Cyprus during the years 1988–1999 were included in the study and they were analyzed according to age, gender, reported reasons for suicide and suicide methods. The main results indicate that: 1. The mean age-standardized suicide rate is the lowest in Europe, in males (3.08/100,000) and also in females (1.05/100,000). 2. Mean suicide rates increase significantly with age in males only. 3. Female suicide rates are highest in the 15–24 age group. 4. Statistically significant rising trends of male and female suicide rates in the all-ages group. 5. Suicide methods were mostly violent. Among males, the most common methods were poisoning, firearms-explosives, and hanging, while in females, jumping, hanging and poisoning. 6. Mental disorders, physical illness, interpersonal and financial problems were the main reported reasons for suicide. The epidemiological characteristics of suicide in Cyprus might be attributed to a combined effect of social and cultural factors and probably reflect influences from countries to which Cyprus is ethnically, historically or geographically related.
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Affiliation(s)
- C A Zacharakis
- University Mental Health Research Institute, Athens, Greece.
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27
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Biochemical, metabolic and immune correlates of seasonal variation in violent suicide: a chronoepidemiologic study. Eur Psychiatry 2020; 11:21-33. [DOI: 10.1016/0924-9338(96)80455-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/1995] [Accepted: 09/11/1995] [Indexed: 11/15/2022] Open
Abstract
SummaryThe purpose of this chronoepidemiologic study was to investigate the time-relationships between the yearly variations in occurrence of violent suicide in Belgium and the yearly variations in various biochemical, metabolic and immune variables in the Belgian population. The weekly mean number of deaths due to violent suicide for all of Belgium for the period 1979–1987 was computed. Twenty-six normal volunteers had monthly blood samplings during one calendar year for assays of plasma L-tryptophan (L-TRP), competing amino acids (CAA), and melatonin levels, maximal [3H]paroxetine binding to platelets, serum total cholesterol, calcium, magnesium, and soluble interleukin-2 receptor concentrations, and number of CD4+ T, CD8+ T and CD20+ B lymphocytes. The annual rhythm in violent suicide rate is highly significantly synchronized with the annual rhythms in L-TRP, [3H]paroxetine binding, cholesterol, calcium, magnesium, CD20+ B cells, and CD4+/CD8+ ratio; the mean peak (violent suicide, [3H]paroxetine binding) or nadir (all other variables) occurs around 3 May. There were significant inverse time-relationships between the time series of violent suicide rate and L-TRP, L-TRP/CAA ratio, total cholesterol, calcium and magnesium, CD4+/CD8+ T cell ratio and number of CD20+ B cells. Maximal [3H]paroxetine binding to platelets was significantly and positively related to the time series of violent suicide. An important part (56.4%) of the variance in mean weekly number of violent suicide rate was explained by the time series of L-TRP, cholesterol and melatonin.
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Reliability and validity of short Beck Hopelessness Scale in psychological autopsy study among Chinese rural elderly. Int Psychogeriatr 2020; 32:525-531. [PMID: 31543084 DOI: 10.1017/s1041610219001315] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Older adults represent the segment of population most exposed to the risk of suicide nearly everywhere in the world. Previous studies showed that hopelessness was an important risk factor for suicide. AIMS This study aimed to evaluate the reliability and validity of the four-item Beck Hopelessness Scale (BHS-4) in psychological autopsy study among Chinese rural elderly. METHOD Two-stage stratified cluster sampling method was used to select research sites. Using case-control psychological autopsy study, face-to-face interviews were conducted to collected information. RESULTS A total of 242 elderly suicide deaths and 242 matched living comparisons were investigated, including 135 males and 107 females for each group. Intraclass Correlation Coefficients (ICC) of the controls were 0.682-0.713. The median score of BHS-4 among suicides was significantly higher than that among controls. The corrected correlation coefficient between items and total score were 0.184-0.723. Cronbach's Alphas coefficient was 0.834. Only one common factor was precipitated by exploratory factor analysis and the cumulative variance contribution rates were 59.558% for suicides and 52.722% for living controls. The correlation coefficient between hopelessness and depression were 0.481 among suicide death and 0.617 among living controls. CONCLUSION The information provided by the informants through psychological autopsy method had high reliability to reflect the actual situation of suicides and controls. BHS-4 has good reliability and validity among Chinese rural elderly suicides. It is suitable for psychological autopsy study among Chinese rural elderly.
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Maung HH. Pluralism and incommensurability in suicide research. STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2020; 80:101247. [PMID: 31902654 DOI: 10.1016/j.shpsc.2019.101247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/29/2019] [Accepted: 12/27/2019] [Indexed: 06/10/2023]
Abstract
This paper examines the complex research landscape of contemporary suicidology from a philosophy of science perspective. I begin by unpacking the methods, concepts, and assumptions of some of the prominent approaches to studying suicide causation, including psychological autopsy studies, epidemiological studies, biological studies, and qualitative studies. I then analyze the different ways these approaches partition the causes of suicide, with particular emphasis on the ways they conceptualize the domain of mental disorder. I argue that these different ways of partitioning the causal space and conceptualizing mental disorder result in incommensurabilities between the approaches. These incommensurabilities restrict the degrees to which the different approaches can be integrated, thus lending support to explanatory pluralism in the study of suicide causation. They also shed light on some of the philosophical underpinnings of the disagreement between mainstream suicidology and the emerging area of critical suicidology.
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Affiliation(s)
- Hane Htut Maung
- Department of Philosophy, School of Social Sciences, Humanities Bridgeford Street, University of Manchester, Manchester, M13 9PL, UK.
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Nestadt PS, Bohnert ASB. Clinical Perspective on Opioids in the Context of Suicide Risk. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:100-105. [PMID: 33162847 PMCID: PMC7587892 DOI: 10.1176/appi.focus.20200003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Psychiatrists are on the front lines of two simultaneous public health crises: the increasing rates of suicide and opioid-related deaths. In this review, the authors discuss ways in which these two classes of preventable deaths may be linked, with an emphasis on identifying and preventing both outcomes through increased understanding of their shared risk factors. As clinicians, it is crucial to maintain awareness of the ways in which opioid use may contribute to depression and suicidality, as well as how mood disorders may complicate opioid use. In light of this interplay, interventions which target risk factors for both suicide and overdose are key. Interventions include early treatment of substance dependence and depression, as well as harm reduction measures, such as provision of naloxone, medication-assisted treatments for dependency, and multidisciplinary approaches to chronic pain that do not rely solely on escalating opioid doses. It is also important to address social determinants of health, which may increase risk for both accidental and intentional overdose. The roads to overdose and suicide overlap considerably and cannot be considered separately.
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Affiliation(s)
- Paul S Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Nestadt); Department of Psychiatry, University of Michigan, and U.S. Department of Veterans Affairs, Ann Arbor, Michigan (Bohnert)
| | - Amy S B Bohnert
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Nestadt); Department of Psychiatry, University of Michigan, and U.S. Department of Veterans Affairs, Ann Arbor, Michigan (Bohnert)
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Suicide amongst the Inuit of Nunavut: An Exploration of Life Trajectories. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061812. [PMID: 32168793 PMCID: PMC7143601 DOI: 10.3390/ijerph17061812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022]
Abstract
This article reports results of the life trajectories from 92 Inuit who died by suicide, matched for age and gender with 92 living-controls. A proxy-based procedure and semi-structured interviews with informants were conducted to obtain trajectories of developmental events occurring over the life course for suicide and community-matched controls. Results from this research indicate two different trajectories that differentiate the control-group from the suicide-group throughout the life course. Even though the number of suicide attempts are similar between both groups, the suicide-group had a more important burden of adversity, which seemed to create a cascading effect, leading to suicide.
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Dutta SE, Gupta S, Raju MSVK, Kumar A, Pawar A. Platelet Serotonin Level and Impulsivity in Human Self-destructive Behavior: A Biological and Psychological Study. J Neurosci Rural Pract 2019; 8:199-203. [PMID: 28479792 PMCID: PMC5402484 DOI: 10.4103/jnrp.jnrp_425_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Context: Suicide is a disease and a global public health problem. Suicidology has come to become a topic of study for intervention and research. The serotonin (5-hydroxytryptamine [5HT]) system has remained a prime area of investigation. The neurons and platelets display structural and functional similarities. Ninety-nine percent of 5HT is contained in platelets, which shares similar 5HT uptake and release mechanisms with 5HT neurons. Aims: This study aims to study human self-destructive behavior (HSDB). Objectives: Exploring the biological (serotonin levels in platelets) and psychological aspects (impulsivity) of attempted suicide or HSDB. Settings and Design: Thirty-one patients, above the age of 18 years, with a recent history of HSDB, were studied and given an International Classification of Diseases-10 diagnosis, after a detailed interview. Subjects and Methods: For the platelet 5HT estimation, blood samples were collected, and enzyme immunometric assay carried out. Detailed assessment of the impulsivity was done by the 25-item structured diagnostic interview for borderlines by Zanarini et al. Statistical Analysis Used: We obtained both categorical and continuous data. Chi-square test, Fisher's test, Student's t-test, and Pearson's product moment correlation were used. Results: Female subjects outnumbered males by 2:1. Major depression, adjustment disorder, personality disorder were predominant diagnoses. The mean platelet serotonin concentration for males = 57.3 ng/ml, that of females = 56.05 ng/ml (P > 0.05). Platelet 5HT levels were found to be negatively correlated with impulsivity scores (P < 0.05). Conclusions: Platelet serotonin levels in our study sample were quite low when compared with those reported in published literature. Low serotonin levels were inversely related to impulsivity, but only in males.
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Affiliation(s)
- S Era Dutta
- Department of Mental Health and Behavioural Sciences, Fortis Healthcare, Mumbai, India
| | - Sriniwas Gupta
- Department of Psychiatry, Military Hospital, Jammu, Jammu and Kashmir, India
| | - M S V K Raju
- Department of Psychiatry, People's College, Bhopal, Madhya Pradesh, India
| | | | - Alka Pawar
- Department of Psychiatry, BJ Medical College, Pune, Maharashtra, India
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Visentin S, Massaro L, Viel G, Cecchetto G, Montisci M. Suicide identification during on-site inspection. Proposal and application of an interpretative method for death scene investigation. Forensic Sci Int 2019; 297:148-155. [DOI: 10.1016/j.forsciint.2019.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
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Problematic Internet Use in University Students Attending Three Superior Graduate Schools in Italy: Is Autism Spectrum Related to Suicide Risk? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071098. [PMID: 30934756 PMCID: PMC6480477 DOI: 10.3390/ijerph16071098] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/24/2022]
Abstract
Background: Over the past decades, problematic internet use (PIU) has dramatically increased, especially among young people. PIU has been recently associated with autism spectrum disorder (ASD) and autistic traits. Subjects with PIU report an increased suicidal risk and the same has been demonstrated among patients with ASD. The aim of this study was to investigate putative PIU rates among students and explore the correlation between autistic traits and suicide risk. Methods: A sample of 178 high achieving university students was assessed by means of the Adult Autism Subthreshold Spectrum (AdAS Spectrum), Autism Quotient questionnaire (AQ). Suicide risk was investigated by some specific items of the Trauma and Loss Spectrum-Self Report (TALS-SR) and putative PIU was identified on the basis of a specific AdAS Spectrum item. Results: 27.5% subjects reporting putative PIU. This subgroup showed higher scores in all domains of AdAS Spectrum and AQ compared with others. Students with putative PIU showed a significant correlation between suicide risk and the non-verbal communication domain of the AdAS Spectrum and the Social skills domain of the AQ. Conclusions: We found that students with PIU show higher levels of autistic traits compared to those without PIU. A significant correlation was found between autistic traits and suicide risk.
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Carreira H, Williams R, Müller M, Harewood R, Stanway S, Bhaskaran K. Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review. J Natl Cancer Inst 2018; 110:1311-1327. [PMID: 30403799 PMCID: PMC6292797 DOI: 10.1093/jnci/djy177] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/08/2018] [Accepted: 08/31/2018] [Indexed: 01/02/2023] Open
Abstract
Background We aimed to systematically review the evidence on adverse mental health outcomes in breast cancer survivors (≥1 year) compared with women with no history of cancer. Methods Studies were identified by searching MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Social Sciences Citation Index, and through backward citation tracking. Two researchers selected the studies, extracted data, and assessed the risk of bias. Results Sixty studies were included. Of 38 studies of depression, 33 observed more depression in breast cancer survivors; this was statistically significant in 19 studies overall, including six of seven where depression was ascertained clinically, three of four studies of antidepressants, and 13 of 31 that quantified depressive symptoms. Of 21 studies of anxiety, 17 observed more anxiety in breast cancer survivors, statistically significant in 11 studies overall, including two of four with clinical/prescription-based outcomes, and in eight of 17 of anxiety symptoms. Breast cancer survivors also had statistically significantly increased symptoms/frequency of neurocognitive dysfunction (18 of 24 studies), sexual dysfunctions (5 of 6 studies), sleep disturbance (5 of 5 studies), stress-related disorders/PTSD (2 of 3 studies), suicide (2 of 2 studies), somatisation (2 of 2 studies), and bipolar and obsessive-compulsive disorders (1 of 1 study each). Studies were heterogeneous in terms of participants' characteristics, time since diagnosis, ascertainment of outcomes, and measures reported. Approximately one-half of the studies were at high risk of selection bias and confounding by socio-economic status. Conclusions There is compelling evidence of an increased risk of anxiety, depression and suicide, and neurocognitive and sexual dysfunctions in breast cancer survivors compared with women with no prior cancer. This information can be used to support evidence-based prevention and management strategies. Further population-based and longitudinal research would help to better characterize these associations.
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Affiliation(s)
- Helena Carreira
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachael Williams
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Rhea Harewood
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Susannah Stanway
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Clapperton A, Newstead S, Bugeja L, Pirkis J. Differences in Characteristics and Exposure to Stressors Between Persons With and Without Diagnosed Mental Illness Who Died by Suicide in Victoria, Australia. CRISIS 2018; 40:231-239. [PMID: 30311798 DOI: 10.1027/0227-5910/a000553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Mental illness is an established risk factor for suicide. To develop effective prevention interventions and strategies, the demographic characteristics and stressors (other than, or in addition to, mental illness) that can influence a person's decision to die by suicide need to be identified. Aim: To examine cases of suicide by the presence or absence of a diagnosed mental illness (mental illness status) to identify differences in factors associated with suicide in the groups. Method: Logistic regression analyses were used to investigate mental illness status and exposure to stressors among 2,839 persons who died by suicide in Victoria, Australia (2009-2013), using the Victorian Suicide Register. Results: Females, metropolitan residents, persons treated for physical illness/injury, those exposed to stressors related to isolation, family, work, education, and substance use and those who had made a previous suicide attempt had increased odds of having a diagnosed mental illness. Employed persons had decreased odds of having a diagnosed mental illness. Limitations: The retrospectivity of data collection as well as the validity and reliability of some of the data may be questionable owing to the potential for recall bias. Conclusion: The point of intervention for suicide prevention cannot always be a mental health professional; some people who die by suicide either do not have a mental illness or have not sought help.
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Affiliation(s)
- Angela Clapperton
- 1 Monash University Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - Stuart Newstead
- 1 Monash University Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - Lyndal Bugeja
- 2 Department of Forensic Medicine, Monash University, Melbourne, VIC, Australia
| | - Jane Pirkis
- 3 Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
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Carrillo P, Fovet T, Poulet E. L’évaluation psychiatrique au service d’accueil des urgences : particularités sémiologiques. ANNALES MEDICO-PSYCHOLOGIQUES 2018. [DOI: 10.1016/j.amp.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Background Research has shown high rates of suicidality in autism spectrum conditions (ASC), but there is lack of research into why this is the case. Many common experiences of autistic adults, such as depression or unemployment, overlap with known risk markers for suicide in the general population. However, it is unknown whether there are risk markers unique to ASC that require new tailored suicide prevention strategies. Methods Through consultation with a steering group of autistic adults, a survey was developed aiming to identify unique risk markers for suicidality in this group. The survey measured suicidality (SBQ-R), non-suicidal self-injury (NSSI-AT), mental health problems, unmet support needs, employment, satisfaction with living arrangements, self-reported autistic traits (AQ), delay in ASC diagnosis, and 'camouflaging' ASC. One hundred sixty-four autistic adults (65 male, 99 female) and 169 general population adults (54 males, 115 females) completed the survey online. Results A majority of autistic adults (72%) scored above the recommended psychiatric cut-off for suicide risk on the SBQ-R; significantly higher than general population (GP) adults (33%). After statistically controlling for a range of demographics and diagnoses, ASC diagnosis and self-reported autistic traits in the general population significantly predicted suicidality. In autistic adults, non-suicidal self-injury, camouflaging, and number of unmet support needs significantly predicted suicidality. Conclusions Results confirm previously reported high rates of suicidality in ASC, and demonstrate that ASC diagnosis, and self-reported autistic traits in the general population are independent risk markers for suicidality. This suggests there are unique factors associated with autism and autistic traits that increase risk of suicidality. Camouflaging and unmet support needs appear to be risk markers for suicidality unique to ASC. Non-suicidal self-injury, employment, and mental health problems appear to be risk markers shared with the general population that are significantly more prevalent in the autistic community. Implications for understanding and prevention of suicide in ASC are discussed.
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Cassidy S, Bradley L, Shaw R, Baron-Cohen S. Risk markers for suicidality in autistic adults. Mol Autism 2018; 9:42. [PMID: 30083306 DOI: 10.1186/s13229-018-02264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/22/2018] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Research has shown high rates of suicidality in autism spectrum conditions (ASC), but there is lack of research into why this is the case. Many common experiences of autistic adults, such as depression or unemployment, overlap with known risk markers for suicide in the general population. However, it is unknown whether there are risk markers unique to ASC that require new tailored suicide prevention strategies. METHODS Through consultation with a steering group of autistic adults, a survey was developed aiming to identify unique risk markers for suicidality in this group. The survey measured suicidality (SBQ-R), non-suicidal self-injury (NSSI-AT), mental health problems, unmet support needs, employment, satisfaction with living arrangements, self-reported autistic traits (AQ), delay in ASC diagnosis, and 'camouflaging' ASC. One hundred sixty-four autistic adults (65 male, 99 female) and 169 general population adults (54 males, 115 females) completed the survey online. RESULTS A majority of autistic adults (72%) scored above the recommended psychiatric cut-off for suicide risk on the SBQ-R; significantly higher than general population (GP) adults (33%). After statistically controlling for a range of demographics and diagnoses, ASC diagnosis and self-reported autistic traits in the general population significantly predicted suicidality. In autistic adults, non-suicidal self-injury, camouflaging, and number of unmet support needs significantly predicted suicidality. CONCLUSIONS Results confirm previously reported high rates of suicidality in ASC, and demonstrate that ASC diagnosis, and self-reported autistic traits in the general population are independent risk markers for suicidality. This suggests there are unique factors associated with autism and autistic traits that increase risk of suicidality. Camouflaging and unmet support needs appear to be risk markers for suicidality unique to ASC. Non-suicidal self-injury, employment, and mental health problems appear to be risk markers shared with the general population that are significantly more prevalent in the autistic community. Implications for understanding and prevention of suicide in ASC are discussed.
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Affiliation(s)
- Sarah Cassidy
- 1School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD UK
- 2Centre for Innovative Research across the Life Course, Coventry University, Coventry, UK
- 3Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Louise Bradley
- 2Centre for Innovative Research across the Life Course, Coventry University, Coventry, UK
| | - Rebecca Shaw
- 2Centre for Innovative Research across the Life Course, Coventry University, Coventry, UK
- Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Simon Baron-Cohen
- 3Autism Research Centre, University of Cambridge, Cambridge, UK
- 5Cambridge Lifetime Asperger Syndrome Service (CLASS), Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Berman AL. Risk Factors Proximate to Suicide and Suicide Risk Assessment in the Context of Denied Suicide Ideation. Suicide Life Threat Behav 2018; 48:340-352. [PMID: 28429385 DOI: 10.1111/sltb.12351] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 02/02/2017] [Indexed: 02/05/2023]
Abstract
Health care providers have significant opportunities to identify individuals at near-term risk for suicide, but lack empirical data on near-term risk factors. This study aimed to identify dynamic, state-related risk factors observed by clinical practitioners within the last 30 days of life of 157 patients who died by suicide and to compare these near-term risk factors among patients who denied versus responded positively to having suicide ideation (SI) when last asked by a clinical practitioner prior to their death. Risk factors charted for the majority of all decedents were a history of prior suicide ideation and/or suicide attempt, current anxiety/agitation and sleep problems, current interpersonal problems or job/financial strain, current comorbid diagnoses, current social isolation/withdrawal, and a family history of mental disorder. Two-thirds of patients denied having SI when last asked and one-half of these patients were dead by suicide within 2 days. Decedents who denied having SI were quite similar in charted diagnoses, symptoms, behaviors, and environmental circumstances to decedents who responded affirmatively to having SI. Reliance on verbalized or reported SI as a gateway to a suicide risk assessment is questioned and the need for better understanding near-term risk for suicide, particularly in the absence of stated SI, is highlighted.
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Affiliation(s)
- Alan L Berman
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Hinkle JT, Perepezko K, Mari Z, Marsh L, Pontone GM. Perceived Treatment Status of Fluctuations in Parkinson Disease Impacts Suicidality. Am J Geriatr Psychiatry 2018; 26:700-710. [PMID: 29609901 PMCID: PMC5993611 DOI: 10.1016/j.jagp.2018.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/03/2018] [Accepted: 01/09/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE On/off motor fluctuations in Parkinson disease (PD) can be associated with extreme mood fluctuations and severe dysphoria. The impact of these affective symptoms may be overlooked in the treatment of motor fluctuations. Our goal was to examine the relationship between motor fluctuations, their treatment status, and suicidality in PD participants. METHODS We analyzed data from the Methods of Optimal Depression Detection in Parkinson's Disease (MOOD-PD) study of 223 individuals with PD. Suicidality was measured using items from four depression scales: Hamilton Depression Rating Scale (HAM-D-17); Montgomery-Åsberg Depression Rating Scale (MADRS); Inventory for Depressive Symptomatology (IDS-C); and the self-rated Beck Depression Inventory (BDI). Multivariable Poisson regression analyses tested whether self-reported motor fluctuations and their treatment status were associated with suicidality while controlling for recognized risk factors. RESULTS Thirty-seven participants (16.6%) self-reported suicidality and 89 (39.5%) self-reported motor fluctuations, of whom 21 (23.6%) perceived their fluctuations as untreated. Participants reporting untreated motor fluctuations more frequently had a current depressive disorder (p < 0.001) and endorsed suicidality (p = 0.006) than participants with treated or no fluctuations. They also had significantly higher total scores on the HAM-D-17, MADRS, IDS-C, and BDI depression scales (p < 0.001 for each). Regression analyses showed significant associations between untreated motor fluctuations and higher scores on suicide questions extracted from the HAM-D-17, MADRS, and IDS-C (p < 0.01 for each). CONCLUSIONS PD patients with untreated motor fluctuations are at increased risk for suicidal thoughts and should be monitored for mood changes as treatment is adapted.
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Affiliation(s)
- Jared T Hinkle
- Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kate Perepezko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zoltan Mari
- Morris K. Udall Parkinson Disease Research Center, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Laura Marsh
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine (LM), Houston, TX
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Morris K. Udall Parkinson Disease Research Center, Johns Hopkins University, School of Medicine, Baltimore, MD.
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Holmstrand C, Bogren M, Mattisson C, Brådvik L. First and Subsequent Lifetime Alcoholism and Mental Disorders in Suicide Victims With Reference to a Community Sample-the Lundby Study 1947-1997. Front Psychiatry 2018; 9:173. [PMID: 29773997 PMCID: PMC5943570 DOI: 10.3389/fpsyt.2018.00173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Suicide victims have been found to frequently suffer from mental disorders, often more than one, and comorbidity has also been found to be a risk factor for suicide. The aim of the present study was to determine the first disorder and possible subsequent disorders in suicide victims during their lifetimes and to compare their development with the development of mental and alcohol use disorders (AUDs) in a community sample. Methods: The Lundby Study is a prospective longitudinal study of mental health in a general population comprising 3,563 subjects, including 68 suicide victims, followed by four field investigations from 1947 to 1997; mortality was monitored up to 2011. Results: AUD was most common as a first diagnosis (26/68, 38.2%) among suicide victims, followed by "depression" (20/68, 29.4%) and "anxiety" (7/68, 10.3%). A predominance of AUD as a first diagnosis was found in the male group, whereas "depression" was the most common first diagnosis in the female group. However, there were very few females with AUD in the Lundby Study. In the whole population, it was more common for someone who started with an AUD to develop a subsequent mental disorder than the other way around. The same was true for AUD in relation to depression. Conclusions: AUD was the most common first mental disorder among male suicide victims and could thus be considered a starting point in the suicidal process. We propose that in addition to detecting and treating depression, it is important to detect and treat AUD vigorously and to be alert for subsequent symptoms of depressive and other mental disorders in suicide prevention efforts.
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Affiliation(s)
| | | | | | - Louise Brådvik
- Division of Psychiatry, Department of Clinical Sciences, Skåne University Hospital, University of Lund, Lund, Sweden
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Meyer J. Novel Phenotypes Detectable with PET in Mood Disorders: Elevated Monoamine Oxidase A and Translocator Protein Level. PET Clin 2018; 12:361-371. [PMID: 28576173 DOI: 10.1016/j.cpet.2017.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
As a result of high prevalence and high rates of treatment resistance, major depressive disorder has become the leading cause of death and disability in moderate-income to high-income nations. Poor targeting of phenotypes is a plausible reason for treatment resistance and PET imaging offers a unique role to identify phenotypes. Both increased monoamine oxidase A binding and greater translocator protein 18 kDa binding occur throughout the gray matter during major depressive episodes, including affect-modulating brain regions such as the prefrontal and anterior cingulate cortex, and are detectable with advanced radioligand technology for both of these targets.
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Affiliation(s)
- Jeffrey Meyer
- Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T1R8, Canada.
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Guarraci FA, Gonzalez CM, Lucero D, Womble PD, Abdel-Rahim H, DeVore J, Kunkel MN, Quadlander E, Stinnett M, Boyette-Davis J. The effects of ketamine on sexual behavior, anxiety, and locomotion in female rats. Pharmacol Biochem Behav 2018; 165:36-44. [DOI: 10.1016/j.pbb.2017.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 12/28/2022]
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Systematic Review of Suicide in Autism Spectrum Disorder: Current Trends and Implications. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0133-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Positive and Negative Suicide Ideation (PANSI) Inventory: Initial Psychometric Properties as a Suicide Risk Screening Tool Among Nigerian University Students. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/1179557317751910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: The objective of this study is to examine the factor structure, validity, reliability, and the screening properties as a suicide risk assessment tool of the 14-item Positive and Negative Suicide Ideation (PANSI) in a nonclinical sample of Nigerian university students. Methods: A total of 514 students completed the PANSI, in addition to the Beck Depression Inventory-II (BDI-II) and the General Health Questionnaire-12 (GHQ-12). Results: Prior to the factor analysis, the sample was randomly divided into two. In one half of the sample (sample 1), exploratory factor analysis of the inventory yielded a 2-factor model (Negative Suicide Ideation [PANSI-NSI] and Positive Ideation [PANSI-PI]), whereas confirmatory factor analysis in the other half (sample 2) produced a 2-factor model with indices of fitness that indicated a satisfactory model fit ( c2 = 93.8; df = 67; χ2/degree of freedom = 1.400; P = .017; goodness of fit index = 0.951; Tucker-Lewis index = 0.964; comparative fit index = 0.974; root mean square error of approximation = 0.040). The internal consistencies of the items of the PANSI-PI and PANSI-NSI subscales were 0.75 and 0.79, respectively. The construct validity of the 2 subscales was modestly satisfactory: PANSI-PI had negative correlations with the GHQ-12 ( r = −.239, P < .001) and the BDI-II ( r = −.190, P < .001), whereas the PANSI-NSI had positive correlations with the GHQ-12 ( r = .248, P < .001) and the BDI-II ( r = .376, P < .001). In addition, a cutoff total score of 17 on the PANSI-NSI was associated with the best sensitivity (80.0%) and specificity (92.5%) in the identification of those students who endorsed experiencing suicidal ideation (area under the curve = 0.82, 95% confidence interval = 0.58-1.00). Conclusions: The PANSI has exhibited satisfactory psychometric properties as a self-rated suicidal behavior assessment instrument in the evaluation of the positive and negative thoughts associated with suicidal ideation among Nigerian university students.
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Abstract
The Health of the Nation asserts that the suicide rate in England and Wales can be reduced by the provision of better health care services. In a sample of suicides in one district health authority, 61% had had contact with health services during the year prior to death, suggesting that improvements in these services could have an impact on the overall suicide rate. However, the proportion who had had prior contact varied between different age and sex groups and individuals in groups with the higher suicide rates tended to have the least contact. Therefore, the impact of health service improvements on the overall suicide rate may be limited.
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Appleby L. Safer services: conclusions from the report of the National Confidential Inquiry. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.6.1.5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In May 1999, the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness published its first major report since it was reestablished at the University of Manchester (Appleby et al, 1999a). Entitled Safer Services, it presented findings from a two-year sample of suicides and an 18-month sample of homicides occurring in England and Wales, and on the basis of these put forward 31 recommendations for mental health services (Appleby, 1999b; Shaw et al, 1999). This article, modified from a chapter in Safer Services, discusses how services might deal with the risk of suicide and homicide or serious violence.
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Abstract
The Joint winners of the second Merck Essay Prize for 1994 were Drs Andrew Smith and Swaran Singh. Their essays are published below. The number of entries was 15.
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Boer H, Booth N, Russell D, Powell R, Briscoe M. Antidepressant prescribing prior to suicide: role of doctors. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.20.5.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The pharmacological treatment of depression and the time elapsed since last seen by a doctor were investigated among 507 adults who subsequently killed themselves. The proportion of people consulting a general practitioner or psychiatrist prior to suicide was lower than reported by the British government in the Health of the Nation document. General practitioners prescribed relatively low doses of antidepressants. Nineteen out of the 115 people receiving antidepressants used the drugs to kill themselves. Our findings emphasise the importance of prescribing adequate doses of antidepressants and underline the need for safer prescribing.
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